273例宫颈上皮内瘤变患者术后切缘阳性的危险因素及预后分析

Analysis on risk factors of positive incisal margins in 273 patients with cervical intraepithelial neoplasia after cold knife conization and the prognosis

目的探讨宫颈上皮内瘤变患者锥切术后切缘阳性高危影响因素及患者预后状况,便于临床评估和指导疾病预后。方法选取273例宫颈上皮内瘤变患者作为本研究对象,所有患者均行锥切术治疗,于术后6个月内对所有患者进行走访调查,记录患者再次手术和病变残留情况,对可能影响切缘阳性的高危因素进行分析比较。结果年龄大、原位癌、HPV感染、CIN病变级别越高、宫颈糜烂严重以及累及上皮腺体的患者行锥切术后切缘阳性发生率相对较高,差异有统计学意义(P<0.05)。CIN患者行锥切术后复发与患者年龄、CIN分级、切缘阳性、病变累及腺体、宫颈感染以及HPV持续感染密切相关(P<0.05)。42例切缘阳性患者中残留率为35.29%,231例切缘阴性患者中残留率为13.79%。结论年龄、原位癌、HPV感染、CIN病变级别、宫颈糜烂程度以及病变累及上皮腺体均是宫颈上皮内瘤变患者锥切术后切缘阳性的高危影响因素,临床上应对锥切术后切缘阳性患者行严密随访。

Objective To explore high-risk factors of positive incisal margins in patients with cervical intraepithelial neoplasia （CIN） after cold knife conization and the prognosis, conduct clinical evaluation and guidance of prognosis. Methods A total of 273 patients with CIN were selected, cold knife conization was carried out, then all the patients were followed up at 6 months after surgery, the reoperation and residual disease situation were recorded, the potential high- risk factors of positive incisal margins were analyzed and compared. Results The incidence rates of positive incisal margins after cold knife conization were higher among the older patients and the patients with carcinoma in situ, HPV infection, higher grade of CIN, more serious cervical ectopic columnar epithelium, and involvement of epithelial glands （ P〈0. 05 ） . Recurrence after cold knife conization was closely correlated with age, CIN grades, positive incisal margins, involvement of epithelial glands, cervical infection, and HPV persistent infection of CIN patients （ P〈0. 05 ） . The residual rates among 42 patients with positive incisal margins and 231 patients with negative incisal margins were 35.29% and 13.79%, respectively. Conclusion Age, carcino- ma in situ, HPV infection, CIN grades, degrees of cervical ectopic columnar epithelium, and involvement of epithelial glands are high-risk factors of positive incisal margins in patients after cold knife conization, the patients with positive incisal margins after cold knife conization should be followed up closely.